4 Research objective and approach Objective To analyse the effect that pharmaceutical innovation the introduction and use of new drugs to treat cancer had on the longevity and hospitalisation of New Zealand cancer patients during the period Research design We investigate whether the cancer sites (e.g. breast, prostate, colon) that experienced more pharmaceutical innovation had larger subsequent declines in premature (before age 70 or 65) mortality and hospitalisation rates and larger subsequent increases in 5-year survival rates, controlling for changes in incidence. Better Health Outcomes for New Zealanders

7 OUTCOME s,t = b k CUM_NCE s,t-k + g ln(incidence s,t ) + a s + d t + e s,t where OUTCOME s,t is one of the following variables: ln(ypll70 s,t ) = the log of the number of years of potential life lost before age 70 due to cancer at site s in year t (t = 2000, 2011) ln(ypll65 s,t ) = the log of the number of years of potential life lost before age 65 due to cancer at site s in year t (t = 2000, 2011) ln(surv5% s,t /(1 = the log-odds of surviving at least 5 years after diagnosis SURV5% s,t )) with cancer at site s in year t (t = 1998, 2010) ln(hosp_days s,t ) = the log of the number of publicly-funded inpatient hospital days for cancer at site s in year t (t = 2004, 2012)

8 OUTCOME s,t = b k CUM_NCE s,t-k + g ln(incidence s,t ) + a s + d t + e s,t CUM_NCE s,t-k IND ds APPROVED d,t-k INCIDENCE s,t a s d t = d IND ds APPROVED d,t-k = the number of new chemical entities (drugs) to treat cancer at site s that had been approved in New Zealand by the end of year t-k = 1 if drug d is used to treat (indicated for) cancer at site s = 0 if drug d is not used to treat (indicated for) cancer at site s = 1 if drug d was approved in New Zealand by the end of year t-k = 0 if drug d was not approved in New Zealand by the end of year t-k = the average annual number of patients diagnosed with cancer at site s in years t-10 to year t = a fixed effect for cancer at site s = a fixed effect for year t

9 Average utilization of new drugs is much lower than average utilization of older drugs The entire cost of very new drugs is borne entirely by patients 23.7 months The mean lag between regulatory approval of a drug in New Zealand and its inclusion in the New Zealand Pharmaceutical Schedule (a list of the prescription medicines and therapeutic products subsidised by the Government) is 23.7 months Barber and Sheehy years years years years years 35+ years Number of years since drug was approved in New Zealand

10 Effect of number of drugs approved by the end of year t-k on potential years of life lost before age 70 in year 7 Premature (before age 70) mortality is inversely related to the number of drugs approved 5 to 16 years earlier ln(ypll70 s,t ) Premature mortality is most strongly inversely related to the number of drugs approved 14 years earlier Note: scale is inverted k Note: vertical lines represent 95% confidence intervals Approval of one additional drug for a cancer site reduces premature mortality from cancer at that site by about 5% 14 years later

11 Potential years of life lost to cancer before age 70 in ,000 45,000 46,881 40,000 36,325 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 actual estimated, if no drugs for treating cancer had been approved in New Zealand during the period

12 Effect of number of drugs approved by the end of year t- k on potential years of life lost before age 65 in year t ln(ypll65 s,t ) Note: scale is inverted k

13 Effect of number of drugs approved by the end of year t-k on odds of surviving 5 years from diagnosis in year t 0.25 ln(surv5% s,t /(1 SURV5% s,t )) The 5-year survival rate is significantly positively related to the number of drugs approved 7 to 25 years earlier, and is most strongly positively related to the number of drugs approved 13 years earlier Between 1998 and 2010, the 5- year survival rate for all adult cancers increased from 57.7% to 63.3%. The estimates indicate that if no new drugs had been approved during , the 5-year survival rate would not have increased between 1998 and 2010.

15 Effect of number of drugs approved by the end of year t-k on number of hospital days in year t ln(hosp_days s,t ) The number of publicly-funded hospital days is significantly inversely related to the number of drugs ever approved 5 to 11 years earlier; it is most strongly inversely related to the number of drugs ever approved 9 years earlier The approval of one additional drug for a cancer site is estimated to reduce the number of publicly-funded inpatient hospital days for cancer at that site by about 5.6% 9 years later Note: scale is inverted

16 Annual public price of all cancers registered with the New Zealand Cancer Registry in 2008 Cost (millions) % of total Public hospital discharges $215 42% Outpatient attendance $112 22% Community and hospital pharmacy dispensing $51 10% Other $133 26% Total $ % In 2008, the cost of public hospital discharges was 4.2 times as great as the cost of pharmacy dispensing This implies that a 5.6% decrease in hospital costs would offset a 23.6% increase in pharmacy costs.

18 Number of hospital discharges in Australia, : actual vs estimated, if no new drugs had been listed on the PBS during ,000,000 9,500,000 9,000,000 actual estimated, if no new drugs had been listed on the PBS during ,497,193 8,500,000 8,435,899 8,000,000 7,500,000 7,000,000 6,500,000 6,000,000 5,500,000 5,735,049 5,000,

19 Estimates of the effects of the number of drugs, the number of chemical subgroups, or both, on outcomes Model Dependent variable ln(ypll70 s,t ) ln(ypll65 s,t ) ln(surv5% s,t /(1 ln(hosp_days SURV5% s,t )) s,t ) Lag (years) CUM_NCE s,t-k Estimat e Z Pr > Z Overall, the estimates suggest that drugs (chemical substances) within the same class (chemical subgroup) are not therapeutically equivalent, i.e. they do not have essentially the same effect in the treatment of a disease or condition CUM_SUBGROUP,t-k Estimat e Z Pr > Z

20 Number of new cancer drugs launched, New Zealand United States

21 Estimates of the effects of drug approvals on US premature (before age 75) cancer mortality Parameter Estimate Standard Z Pr > Z Model Error 1 cum_drug (all drugs) <.0001 In general, the drugs that were not launched in New Zealand were no less valuable than the drugs that were launched in New Zealand 2 2 cum_nz (drugs launched in both the U.S. and NZ) cum_not_nz (drugs launched in the U.S. and not launched in NZ)

22 Summary and conclusions Between 1998 and 2010, the 5-year survival rate for all adult cancers increased from 57.7% to 63.3%. The estimates indicate that if no new drugs had been approved during , the 5-year survival rate would not have increased between 1998 and Drugs for treating cancer that were approved in New Zealand during the period are estimated to have reduced the number of life-years lost to cancer before age 70 in 2011 by 10,556. Even if we don t account for the apparent reduction in hospital utilization, the cost per life-year gained from previous pharmaceutical innovation (< $500) is well below the vast majority of estimates from the value-of-life literature of the value of a life-year. When the reduction in hospital utilization is taken into account, the evidence indicates that pharmaceutical innovation was cost-saving. Better Health Outcomes for New Zealanders

23 Summary and conclusions Overall, the estimates suggest that drugs (chemical substances) within the same class (chemical subgroup) are not therapeutically equivalent, i.e. they do not have essentially the same effect in the treatment of a disease or condition. During the period , the number of cancer drugs launched in New Zealand was only half the number launched in the U.S. (68 vs. 139). Evidence from U.S. data indicates that the drugs that were not launched in New Zealand were no less valuable than the drugs that were launched in New Zealand. Better Health Outcomes for New Zealanders

24 Pharmaceutical innovation also reduces disability and increases ability to work: evidence based on U.S. data Longitudinal state-level data during the period were analyzed to investigate whether use of newer prescription drugs reduced the ratio of the number of workers receiving Social Security Disability Insurance benefits to the working-age population (the DI recipiency rate ). All of the estimates indicated that there is a significant inverse relationship between disability recipiency and a good indicator of pharmaceutical innovation use: the mean vintage (FDA approval year) of Medicaid prescriptions. From 1995 to 2004, the actual disability rate increased 30%, from 2.62% to 3.42%. The estimates imply that in the absence of any post-1995 increase in drug vintage, the increase in the disability rate would have been 30% larger: the disability rate would have increased 39%, from 2.62% to 3.65%. This means that in the absence of any post-1995 increase in drug vintage, about 418,000 more working-age Americans would have been DI recipients. Better Health Outcomes for New Zealanders

25 Pharmaceutical innovation also reduces disability and increases ability to work: evidence based on U.S. data The mean number of work loss days, school loss days, and hospital admissions declined more rapidly among medical conditions with larger increases in the mean number of new (post-1990) prescription drugs consumed. The value of reductions in work loss days and hospital admissions attributable to pharmaceutical innovation was estimated to be three times as large as the cost of new drugs consumed. Better Health Outcomes for New Zealanders

26 Correlation across conditions between pharmaceutical innovation and change in probability of work-loss, top 30 conditions (ranked by number of employed persons who missed work because of the condition during ) 0.3 Log change between and in fraction of employed persons with the condition who missed work because of the condition y = x R² = Change between and in fraction of prescriptions used to treat the condition that contained post-1990 ingredients

29 The impact of pharmaceutical innovation on the longevity and hospitalization of New Zealand cancer patients, Frank R. Lichtenberg, Ph.D Columbia University and National Bureau of Economic Research Jenni M. Williams-Spence, Ph.D Arrus Knoble, Management Consultants Better Health Outcomes for New Zealanders

Epidemiology of Cancer in Department of Public Health Revised April 212 Introduction The general public is very concerned about cancer in the community. Many residents believe that cancer rates are high

David Feltl, M.D., Ph.D., MBA Structure and organization of cancer care in the Czech Republic. Assessment of outputs and outcomes. Contents Cancer epidemiology in the Czech Republic National oncology program

Chapter I Overview Chapter Contents Table Number Contents I-1 Estimated New Cancer Cases and Deaths for 2005 I-2 53-Year Trends in US Cancer Death Rates I-3 Summary of Changes in Cancer Incidence and Mortality

North America Canada Canadian 1951 Schmidt & Popham (1981) 1951 70 9 889 alcoholic men, aged 15 years, admitted to the clinical service of the Addiction Research Foundation of Ontario between Death records

Projections of the Costs Associated with Cancer Care in the United States October 8, 2012 Robin Yabroff, Ph.D Health Services and Economics Branch Division of Cancer Control and Population Sciences National

Health Factsheet February 27, 2013, INP-13-1 A Publication of the National Registry of Diseases Office, Singapore Trends of Colorectal Cancer in Singapore, 2007-2011 1. Introduction The large intestine

Survival ratios of cancer patients by area in Finland Pages 2 14 present the relative survival ratios for patients diagnosed in 2005 2012 and followed-up in 2010 2012 (see Methods p. 15) on different university

The effect of the introduction of ICD-10 on cancer mortality trends in Anita Brock, Clare Griffiths and Cleo Rooney, Offi ce for INTRODUCTION From January 2001 deaths in have been coded to the Tenth Revision

MOH Policy for dispensing NEOPLASTIC DISEASES DRUGS All prescriptions for antineoplastic drugs must be accompanied by the MOH special form. All the attachments mentioned on this form shall be submitted

The Price of Cancer The public price of registered cancer in New Zealand Citation: The Price of Cancer: The public price of registered cancer in New Zealand. Wellington: Ministry of Health. Published in

Texas Public Health Journal A quarterly publication of the Texas Public Health Association (TPHA) Supplement Fall 2013 A Comprehensive Report on Cancer among Hispanics in Texas Percent Change in Hispanic

A. Name and location of hospital:, Indianapolis, IN B. Name of cancer center: St. Vincent Oncology Center C. Identify PI and key personnel with contact information for each pilot focus areas: a. Disparities

Cancer in Western Australia: Incidence and mortality 2003 and Mesothelioma 1960-2003 A report of the Western Australian Cancer Registry Health Data Collections, Information Collection and Management Department

9 Expenditure on breast cancer Due to the large number of people diagnosed with breast cancer and the high burden of disease related to it, breast cancer is associated with substantial health-care costs.

MERCY REGIONAL CANCER CENTER 2012 CANCER PROGRAM ANNUAL REPORT Using 2011 Data Mercy Regional Cancer Center When you have cancer, you might think first of treatments chemotherapy and radiation. You want

Radiotherapy report sets new targets for Europe Anna Wagstaff Radiotherapy is the most cost-effective treatment for many cancers. Now radiation oncologists have adopted an evidence-based approach to assessing

Prostate cancer in Australia The following material has been sourced from the Australian Institute of Health and Welfare Prostate cancer incorporates ICD-10 cancer code C61 (Malignant neoplasm of prostate).

Hazardous Medicines The majority of medicines are not classed as hazardous. The only medicinal products that are automatically deemed to be hazardous are cytotoxic and cytostatic medicines. There is no

6 Conclusions Key points Many people for whom asthma management guidelines would recommend using inhaled corticosteroids are not using them regularly. At the same time, most inhaled corticosteroids that

Assessment of the Occurrence of Cancer East Harris County, Texas 1995 2012 June 19, 2015 Prepared by the Texas Department of State Health Services Investigation# 14004 Table of Contents Executive Summary...

Selected Health Status Indicators DALLAS COUNTY Jointly produced to assist those seeking to improve health care in rural Alabama By The Office of Primary Care and Rural Health, Alabama Department of Public

Statistics fact sheet Fact sheet last updated January 2015 EXTERNAL VERSION Macmillan Cancer Support Page 1 of 10 Macmillan and statistics Statistics are important to Macmillan because they help us represent

Cancer Treatments Subcommittee of PTAC Meeting held 2 March 2012 (minutes for web publishing) Cancer Treatments Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology

Dr. Anthony C.H. YING What are? Tumour markers are substances that can be found in the body when cancer is present. They are usually found in the blood or urine. They can be products of cancer cells or

Cancer in Australia an overview 212 Cancer in Australia: an overview, 212 presents the latest available information on incidence, mortality, survival, prevalence, burden of cancer, hospitalisations and

AIG Life Critical Illness with Term Assurance Our comprehensive Critical Illness with Term Assurance delivers more value and quality to the customer and their family than ever before. It is designed to

Cost of Cancer in NSW A report by Access Economics Pty Limited for Prepared with information available to June 2006 and published in April 2007. TABLE OF CONTENTS Preface... i Acknowledgements and Disclaimer...iii